Where private foundations stand in global health governance?

Bridget Jeanne addresses the complex position private foundations are in within global health, and how their soft power may possibly supersede the influence states such as the United Kingdom and United Sates in shaping how the governance of global health.

Twenty-seven of the world’s wealthiest private foundations, with assets collectively valued at 360 billion USD give 15 billion annually to philanthropic causes, with the Bill and Melinda Gates Foundation (BMGF) leading the list with their contribution of 2.6 billion USD. Private foundations contributing to global health is not new (the Rockefeller Foundation was established in 1913 and the Ford Foundation in 1936) but with the overwhelming fiscal power of the BMGF since 2000, it has increased their soft power by ten-fold in influencing what and how global health issues are engaged with. Most significantly to date, the BMGF’s contribution to international vaccine alliance GAVI tops donations from nations including the U.S. and the United Kingdom in 2015.

It is clear at this point that the financial prowess of private foundations are formidable but what makes them unique to global health governance today is the soft power they exert. Private Foundations like the BMGF and the Clinton Foundation are divided from conventional politics and build upon a business-orientated framework. They are not subject to popular elections nor bounded to state subscription to international agreements between states (and state-centric political navigation), and fundamentally operate as businesses. The foundations’ gargantuan fiscal power in association with their independence from conventional politics have propelled them to become household names in the global health cause.

As trade and migration becomes travels further distances, health in global governance simultaneously rises in priority. Globalisation has puts states in a stressful position of making it necessary to contribute to altruistic causes to culminate in good public image and complying with regional and global organisations such as the World Health Organisation (WHO) and United Nations (UN) while seeking to fulfill their people’s demands. States in lower-socioeconomic positions find it increasingly harder to involve themselves in global health politics because of weak health care systems, populations suffering from high mortality rates and undermined voices at the global political table. It is difficult for states to establish for themselves an unadulterated altruistic front without hinting at a self-centric agenda.

These unclear agendas are where private foundations thrive and dominate global health governance, displacing an era when states led the discussions. Extending from fiscally-stable companies, these foundations are able to bring to global health the fiscal capacity and should they have hidden agendas, their founders wield powerful public images that mask the agendas well. Criticisms of these private foundations are often isolated within a small community thus, difficult to permeate the public sphere. At just 48, Bill Gates announced that he would be prioritising his focus towards the BMGF shifting away from Microsoft, encapsulating the Gates with an altruistic image. Altruism has become an important factor in building public image in the past decade to detract the neoliberal capitalism market, which has undergone strong public criticism in recent years.

In evading public scrutiny, private foundations are afforded greater autonomy is how they shape the global health agenda by attaching strict conditionalities to their financial contributions. After the U.S., the BMGF is the second largest donor to WHO. While the BMGF’s donations are undeniably useful, their contributions are “specified” and can only be utilised for issues decided by the foundation, inadvertently limiting WHO’s capacity in allocating resources in the best possible manner. This could arguably be due to a distrust of the organisations to do just to the funds provided but as we will observe, the science and technology centered approach of private foundations result in a neo-colonial power structure that not only undermines states but also displaces smaller foundations and charities.

Private foundations predominantly stem from families with massive fortunes established in businesses which thrive on science and technology consumerism – BMGF from Microsoft, Ford Foundation from Ford Motor Company and Rockefeller Foundation from Standard Oil. Their success in their respective industries informally make them experts of field and so when the BMGF and Clinton Foundation’s joint venture AGRA (‘Alliance for Green Revolution in Africa’) say that “the current food system is not capable of delivering good nutrition to all” and only through “using market-oriented approaches” will ensure nutritious food (Bill and Melinda Gates Foundation, 2016), we believe them. As the BMGF invests heavily in multiple platforms to promote investment in African agriculture, it hinders a critical analysis of their methods.

These foundations are without doubt, have redefined what it means to govern global health essentially transforming the platform into a market and more critical analysis needs to be done to clearly distinguish their capacity in shaping global health governance.

The views expressed in this article are those of the author and do not necessarily represent the views of Development in Action.